Angioplasty guide catheter

ABSTRACT

An angioplasty guide catheter adapted for use within a cardiovascular system and cooperable with a left main coronary artery. The guide catheter has a distal end portion such that with a distal tip of the distal end portion coaxially intubated within an ostium of the left main coronary artery fully disposed within the cardiovascular system, a portion of the distal end portion rests against and is substantially contiguous with a wall of the ascending aorta. A distal end of the resting portion is substantially directly opposite the ostium of the left main coronary artery and a portion of the distal end portion defines a generally rectilinear axis of support extending from the distal end of the resting portion across the ascending aorta to the ostium of the left main coronary artery.

This application is a continuation of application Ser. No. 08/475,946,filed Jun. 7, 1995, which in turn is a continuation of application Ser.No. 08/259,567, filed Jun. 14, 1994, now U.S. Pat. No. 5,445,625, whichin turn is a continuation of application Ser. No. 07/969,891, filed onOct. 30, 1992, now abandoned which in turn is a continuation-in-part ofapplication Ser. No. 07/622,873, filed on Jan. 23, 1991, now abandoned.

BACKGROUND OF THE INVENTION

This invention relates generally to catheters adapted to be insertedinto the cardiovascular system of a living body and, more particularly,to an improved catheter having an improved distal end portion for moreprecise location in the particular artery of the cardiovascular system.

Catheters are often used in the performance of medical procedures suchas coronary angiography for injecting dye, or the like, into thecardiovascular system for diagnosis; and angioplasty to widen the lumenof a coronary artery which has become at least partially blocked by astenotic lesion causing an abnormal narrowing of the artery due toinjury or disease. In these techniques the distal end of the catheter isintroduced into the aorta by way of the femoral artery. The proximal endof the catheter is then manipulated so its distal end is inserted intothe lumen of a selected coronary artery branching off from the aorta. Atypical angioplasty procedure would involve initially inserting aguiding catheter into the cardiovascular system in the above manner,followed by a dilating catheter, a laser catheter, an atherectomycatheter, or the like, which is guided through the guiding catheteruntil its distal end portion is positioned within the stenotic lesion inthe coronary artery to reduce the blockage in the artery. A diagnosticcatheter would be used in the same manner.

The most common catheter used in treatment of the left coronary arteryis what is often referred to as a "Judkins" catheter which has aspecially shaped distal end portion for facilitating insertion into theartery. However, as will be specifically discussed, there are somedisadvantages to the "Judkins" catheter, including its inability toalign perfectly coaxially with selected artery and thus permit optimumtreatment, and its inability to adequately support other devices such asballoon catheters. Also, the Judkins catheter forms relatively largeangles when inserted into the cardiovascular system thus dissipatingsome of the axial forces transmitted through the catheter during use.

The Judkins-type catheter originally was designed and used fordiagnostic angiography. However, with the advent of angioplasty, theJudkins-type catheter has been used routinely for about the lastfourteen years to guide balloon catheters and other intravasculardevices through the vasculature to the left main coronary artery. Theoverall shape/configuration of the Judkins-type catheter has remainedbasically the same throughout this period. Although some variations inits shape/configuration were made, the basic overall shape of theJudkins-type catheter has not been specifically adapted for the uniqueneeds dictated by angioplasty procedures. Instead, the Judkins-typecatheter (as commonly used in a left femoral approach technique forintubating the left main coronary artery) has been adapted only slightlyfrom its original configuration that was designed for diagnosticangiographic procedures.

Accordingly, the Judkins-type catheter presents several difficultieswhen used for angioplasty procedures. Significantly, the principleproblem associated with the use of a Judkins-type catheter as a guidingcatheter is the lack of backup support which results in severalundesirable consequences. When a Judkins-type guide catheter is disposedin the cardiovascular system and one attempts to push the ballooncatheter distally across a tight stenosis, a resultant (oppositeproximal) force is generated by the balloon catheter against the guidecatheter. This problem is described in depth in Danforth U.S. Pat. No.4,909,787. The result is that the tip of the Judkins-type catheter maybecome dislodged from the ostium of the left main coronary artery, i.e.,the distal portion of the catheter "prolapses" and loses its preferredorientation within the ascending aorta and left main coronary artery.After this occurs, further advancement of the balloon (or other) workingcatheter becomes nearly impossible because the Judkins guiding catheterno longer provides adequate support to the highly flexible shaft of theballoon catheter as one attempts to push the balloon catheter across thetight stenosis.

Various attempts to solve this problem are described in the prior art.One of these attempted solutions is set forth in Danforth U.S. Pat. No.4,909,787 which describes a modified Judkins-type guiding catheter inwhich the "secondary curve" of the catheter includes a controllablestiffening means. This stiffening means is activated when the Danforthcatheter is disposed within the cardiovascular system so that when oneattempts to push a balloon catheter across a tight stenosis, thestiffening means on the outer curvature of the secondary curve countersthe force exerted against the guide catheter because of the resistanceof the stenosis. This stiffening means is said to maintain enoughrigidity in the guiding catheter to maintain the tip portion of theguiding catheter within the ostium of the left main coronary arterythereby preventing prolapse of the guiding catheter. Similarly, DanforthU.S. Pat. No. 4,822,345 provides an inflatable/deflatable balloon 50which works in a manner similar to the catheter in the Danforth U.S.Pat. No. 4,909,787 to increase the rigidity of the distal end of theguiding catheter. Both of these references describe modifiedJudkins-type guide catheters in which it was attempted to increaseballoon catheter backup support by increasing the stiffness of the outercurvature of the distal end portion of the guide catheter and thusprevent the guide catheter from prolapsing during balloon catheteradvancement distally across a stenosis. Neither of the Danforth patentsattempted to make a fundamental change in the overallshape/configuration of the Judkins-type guide catheter to solve theproblem of inferior backup support.

Shiu U.S. Pat. No. 5,098,412 describes a Judkins-type guide catheterhaving a secondary lumen in addition to a main lumen through which aballoon catheter passes. The secondary lumen structure is separable fromthe main lumen at the distal portion so that when a distal end of themain lumen of the guide catheter is intubated in the ostium (LMCA), thesecondary lumen is moved away from the main lumen (at the distalportion) and may be braced against the opposed walls of a vessel toretain the position of the guide catheter. As in the other attemptedsolutions to the problem of balloon catheter back up support, the Shiuapproach adds bulky complex structure to a Judkins guide catheterinstead of fundamentally altering the basic configuration of the Judkinsguide catheter to solve the problem. Despite the modification of theJudkins guide catheter, the Shiu guide catheter retains the overallconfiguration of the Judkins catheter that results in the apex of thesecondary curve portion of the Judkins-style guide catheter "banking" ofthe wall of the ascending aorta at a location substantially above theostium.

Other solutions include trying to "lock" the tip portion of theJudkins-type guiding catheter within the ostium of the left maincoronary artery. For example, Patel U.S. Pat. No. 5,000,743 discloses aninflatable balloon on the distal end of the guide catheter for securingthe distal end within the lumen of a coronary artery. Alternatively,Patel U.S. Pat. No. 4,781,682 discloses another type of Judkins-typeguide catheter with a "locking" device consisting of support flaps,which expand from the outer surface of the guide catheter, to anchor thedistal end portion of the guide catheter adjacent the left main coronaryartery. However, these attempted solutions have their own undesirableresults. The former solution impedes blood flow through the left maincoronary artery and the latter solution introduces additional bulkystructure into the cardiovascular system which may hamper the blood flowand interfere with the functioning of the aortic valve. Similarly, DuessU.S. Pat. No. 5,122,125 describes a Judkins-type guide catheter having a"centering" or "locking" top portion in which ridges on the outersurface of the distal tip portion effectively wedge against the innerwalls of an ostium to center the tip portion within the ostium. Thisfeature is said to allow proper blood flow around the distal tip portionas well as effectively "anchor" the distal tip portion within the ostiumthereby insuring stable and precise positioning of the guide catheter.

These previous modifications of the Judkins catheter for angioplastyhave not addressed the primary reason for frequent prolapse of theJudkins-type guide catheter when advancing a balloon catheter across astenosis: the overall shape of the Judkins guide catheter (prior toinsertion in the cardiovascular system) is poorly designed forangioplasty purposes. There are several features of the basic shape ofthe Judkins guide catheter (for left main coronary arteries or "LMCA")that cause poor performance in using Judkins or slightly modifiedJudkins guide catheters in angioplasty procedures.

The main deficiency in the previous attempted modifications of theJudkins catheter (as used for guide catheter purposes in the LMCA) hasbeen a lack of appreciation for the extent to which the shape of theJudkins guide catheter prior to insertion in the cardiovascular systemaffects its performance (i.e., coaxial positioning, backup support) whenthe Judkins guide catheter is disposed within the cardiovascular system.

The first deficiency in the shape of the Judkins catheter is that theprimary curve of the Judkins guiding catheter forms a 90° right angleprior to insertion in the cardiovascular system and is relativelyinflexible (the primary curve corresponds to the first curve in thecatheter proximal of its utmost distal end). This causes the distal tipportion of the Judkins-type catheter to be incapable of aligningcoaxially within the ostium of the left main coronary artery. The 90°angle of the primary curve hampers the ability of the balloon catheterto exit the tip portion of the guiding catheter because this frequentlycauses the balloon catheter to exit the tip portion into the wall of theleft main coronary artery. Accordingly, deep intubation of the distaltip portion within the ostium, which is desirable to increase supportfor advancing a balloon catheter across a stenosis, is extremelydifficult and not practical with the Judkins guide catheter. Moreover,this 90° primary curve also generally limits the distance which thedistal tip portion may be intubated into the left main coronary artery.

Similarly, this misalignment of the tip portion prevents the fulltransfer of pushing force from the proximal end of the balloon catheterto the distal end of the balloon catheter because the balloon cathetermust bend around the steeply angled primary curve tip portion of theJudkins-type catheter before aligning properly within the ostium andlumen of the left main coronary artery. This problem with the Judkinsguide catheter when used for angioplasty is directly attributable to thebelief that one must prevent intubation of the Judkins guide catheterwithin the ostium and the LMCA. This belief was based on the strongreluctance to put such a catheter into the left main coronary arterybecause of the relatively large size of diagnostic catheters at time ofdevelopment of the Judkins catheter.

Moreover, the 90° angle primary curve causes particular problems whenattempting to maneuver a balloon catheter into the circumflex branch ofthe left main coronary artery. The circumflex branch extends from theostium in the left main coronary artery in a direction almost directlyopposite the exit of the balloon catheter from the distal tip portion ofthe 90° primary curve of the Judkins guide catheter. Accordingly, whenattempting to maneuver a balloon catheter into the circumflex branch,the balloon catheter must first negotiate the 90° primary curve of theJudkins catheter and then completely reverse direction (about 180°) toenter the circumflex branch of the left main coronary artery. Thissignificantly attenuates pushing forces transmitted from the proximalend of the balloon catheter to the balloon portion thereby making thecrossing of a lesion or stenosis much more difficult.

However, the sharp 90° angle of the primary curve is not the onlyfeature of the shape of the Judkins guide catheter that hampers coaxialplacement and stable positioning of the distal tip portion within theostium of the left main coronary artery. The other main feature of theJudkins guide catheter (for LMCA) is a long straight segment extendingdistally of the secondary curve (and proximal of the primary curve) andthe absence of any other significant curves formed along the length ofthe catheter (other than the conventional 180° secondary andconventional primary curve). This creates several consequences whichcombine to cause noncoaxial ostial positioning and poor backup supportof the Judkins guide catheter for LMCA.

The first consequence of having the long straight segment extendingdistally of 180° secondary curve is that when the distal tip and primarycurve portion of the Judkins guide catheter are positioned within theostium of the LMCA, the long straight segment of the Judkins guidecatheter distal of the secondary curve (and proximal to the primarycurve) extends upwardly from the ostium and across the ascending aortaat a substantial (i.e., sharp) angle so that the Judkins guide cathetercontacts the wall of the ascending aorta substantially above the ostiumof the LMCA. After contacting the wall of the ascending aorta, theJudkins guide catheter extends proximally away from the aortic wall at asubstantial angle (relative the aortic wall) toward the arch of theaorta before again contacting a wall of the descending aorta adjacentthe arch of the aorta. Thus, the Judkins guide catheter effectivelybanks off the wall of the ascending aorta.

The long straight segment extending distally of the 180° secondary curveportion is significant because it is that segment which allows thedistal end portion of the Judkins catheter to become anchored within theaortic root complex. This long straight segment (distal of the secondarycurve portion) is noticeably longer than the diameter of the ascendingaorta and has the following effect: when the utmost distal tip andprimary curve portion of the Judkins catheter are intubated within theostium of the left main coronary, the long straight segment (distal ofthe secondary curve portion) becomes "wedged", i.e., anchored betweenthe ostium (of LMCA) and the wall of the ascending aorta (where the apexof the secondary curve portion contacts the wall). Without this longstraight segment distal of the secondary curve portion, the Judkinsguide catheter would slip against the wall of the ascending aorta as oneattempted to further advance the guide catheter into the ostium, therebycausing unstable positioning of the Judkins guide catheter.

Accordingly, the long straight segment distal of the secondary curveportion of the Judkins guide catheter is made appreciably longer thanthe diameter of the ascending aorta so that this "wedging" phenomenaoccurs. It is because this long distal straight segment is appreciablylonger than the diameter of the ascending aorta that the apex of thesecondary curve portion contacts the ascending aortic wall substantiallyabove the ostium of the left main coronary artery.

The portion of the Judkins guide catheter that contacts or "banks off"the ascending aortic wall (the contact portion) corresponds roughly tothe apex of the curvature of the 180° bend secondary curve. This contactportion is relatively small and approximates a single point on a linesuch that the contact portion will act as a localized pressure point onthe wall of the ascending aorta. It is generally desirable to spread outany pressure exerted on a wall of a blood vessel such as the ascendingaorta.

More importantly, the small size of the contact portion in its locationsubstantially above (not directly across from) the ostium of the LMCAdirectly cause the poor backup support of the Judkins guide catheterwhen advancing a balloon catheter across a stenosis. First, because thesurface area of contact between the contact portion and the aortic wallis so small, the Judkins guide catheter is much easier to dislodge fromits position against the wall when resistive "pushback" forces areencountered during advancement of a balloon catheter across a stenosis.Moreover, the straight portion of the Judkins guide catheter (distal ofthe secondary bend) extends downward through the ascending aortasubstantially lateral relative to the contact portion. This allows thestenotic "pushback" forces to more easily overcome the friction of thesmall contact area between the Judkins guide catheter and the aorticwall and dislodge the Judkins guide catheter from the desiredorientation in the aortic complex. However, the potential for dislodgingthe Judkins catheter from its desired position is not the mostdisadvantageous aspect resulting from the overall configuration of the180° secondary curve, 90° primary curve and absence of other curvedportions in the Judkins guide catheter.

As explained earlier, the most significant problem associated with thebasic shape of the Judkins guide catheter is prolapse (i.e., retractingor "backing out" of the distal tip) of the Judkins catheter from theostium when advancing the balloon catheter. Prolapse of the Judkinsguide catheter occurs because the "pushback forces" are directed alongan axis generally parallel to the ostium of the left main coronaryartery through the ascending aorta whereas the Judkins guide catheterpoint of support is a small contact point substantially above theostium. The stenotic "pushback" forces tend to push the distal tipportion of the Judkins catheter out of the ostium and toward theopposite wall of the ascending aorta. During this prolapse of the distaltip portion, the apex of the secondary curve of the Judkins catheterrests against the aortic wall and acts as a hinge allowing the straightportion (distal of the secondary curve) to bend backwards toward theopposite wall.

The prolapse of the Judkins guide catheter when advancing a ballooncatheter is a direct consequence of having a small point of contactagainst the aortic wall substantially above the ostium. The Judkinsguide catheter lacks support to counter pushback forces where it needsit most; directly across from the ostium. The basic positioning of theJudkins guide catheter within the cardiovascular system and ascendingaorta is dictated by the basic shape of the catheter when in a relaxedstate prior to insertion. In particular, the long straight segmentextending distally from the 180° secondary curve (and lack of othercurves throughout the length of the catheter other than the primarycurve) result in this positioning within the ascending aortasubstantially above the ostium of the left main coronary artery.Moreover, recall that attempted solutions (in the Danforth patents) torectify the prolapse problem of the Judkins guide catheter did notrecognize that the basic shape of the Judkins guide catheter was thecause of the prolapse but rather merely added structure to the samebasic shape in an attempt to prevent prolapse. Likewise, the Patelpatents did not recognize that the problem of prolapse is caused by thebasic shape of the Judkins catheter but rather tried to anchor thedistal tip portion of the catheter near the aortic root to "lock" theguide catheter within the aortic complex near the ostium. None of theattempted solutions recognize, must less solve, the problem with theJudkins guide catheter--its basic shape prior to insertion in thecardiovascular system--a combination of a primary curve with a 90°angle, a 180° secondary curve with a long straight segment extendingdistally therefrom, and no other curves throughout the length of thecatheter. This configuration results in the absence of a point or axisof support directly across from or opposite the ostium of the left maincoronary artery.

Another problem with the Judkins guide catheter is that each bend in theJudkins guide catheter (when disposed fully in the aorta complex) formsat least a 90° angle and or an acute angle (less than 90°). Acute (or90°) angles in the Judkins catheter cause great resistance to pushingthe balloon catheter through the Judkins guide catheter. This happensbecause the Judkins catheter prior to insertion has only two largecurves including the 180° (or 150°) secondary curve and the 90° primarycurve, and has no other curved portions throughout its length.

This is significant because the catheter must trace a 180° path aroundthe arch of the aorta and then another 90° turn into the ostium of theleft main coronary artery creating an overall path from the descendingaorta to the ostium of the LMCA of about 270°. Having fewer curves inthe catheter prior to insertion in the cardiovascular system means thatas the guide catheter traces this 270° path each curve will form agreater (i.e., sharper) angle and thus, each acute angle willproportionately reduce the transmission of pushing forces when distallyadvancing a balloon catheter. Conversely, having more curves throughoutthe length of the catheter in a relaxed state prior to insertion in thecardiovascular system will mean that each curve can form a more moderate(obtuse) angle when the guide catheter is disposed in the cardiovascularsystem and in particular, the aortic arch and ascending aorta. Thisallows for an overall better transmission of pushing forces because nosingle curve will form less than a 90° angle.

The problem of 90° or acute angled (90° or less) bends in the Judkinscatheter when fully disposed in the aortic complex illustrates the poordesign of the Judkins guide catheter for supporting distal advancementof a balloon catheter through the Judkins guide catheter. Had theJudkins catheter been designed for angioplasty, the configuration of theJudkins guide catheter would incorporate a combination of curvedportions so that when disposed in the aorta, the angles of the bendswould be milder, i.e., obtuse, to facilitate a fuller transmission ofdistal pushing forces in the balloon catheter.

Thus, several main problems are attributable to the basic shape of theJudkins guide catheter. First, coaxial intubation is difficult with a90° primary curve. Second, the point of support of the Judkins guidecatheter against the aortic wall acts as a hinge to allow prolapse ofthe distal tip out of the ostium because the point of support issubstantially above the ostium. Moreover, the small surface area ofcontact between the contact portion and the aortic wall makes it easy todisplace the catheter when stenotic pushback forces are encountered.Third, acute angles of the Judkins catheter (when disposed within theaortic complex) reduce the transmission of pushing forces from theproximal end of the balloon catheter to its distal end when attemptingto advance the balloon catheter across the tight stenosis.

SUMMARY OF THE INVENTION

The present invention relates to a guiding catheter which isspecifically designed to facilitate the maneuvering of a balloondilatation catheter or other type catheter into a left main coronaryartery. Previous catheters used for this purpose include theJudkins-type catheter.

The present invention recognizes that the problem of backup support mustbe solved by making a fundamental change in the overallshape/configuration of guiding catheters used for left main coronaryarteries. This results in a simple guide catheter that is practical inuse without the need for complex or bulky adaptations (additionalstiffening means, locking devices, or bracing means) to augment thebasic guide catheter. In particular, instead of attempting to increasethe stiffness of the distal end portion of the Judkins guide catheter orproviding a "locking" or "bracing" mechanism to prevent prolapse of theguide catheter, the present invention makes a significant change in theoverall shape/configuration of a guide catheter in several ways.

The uniqueness of the guide catheter of the present invention resultsfrom having analyzed the factors that determine optimal support of aguide catheter within an aortic root complex and arranging these factorsin a way to maximize backup support for distal advancement of a ballooncatheter through the guide catheter of the present invention. Thefactors determining the support provided by the guide catheter includethe following. First, coaxial intubation of a distal tip of the guidecatheter within the ostium of the left main coronary artery. Second, thelack of steep bends or acute angles throughout the length of the guidecatheter when deployed in the cardiovascular system. Third, a point ofsupport of the guide catheter against the wall of the ascending aortathat is directly across from the ostium of the left main coronaryartery. Fourth, a large supportive segment of the guide catheter thatrests against the wall of the ascending aorta to increase stability ofthe guide catheter within the aortic complex. Fifth, providing asubstantially rectilinear axis of support between the ostium of the leftmain coronary artery and the point of support against the wall of theascending aorta. Sixth, providing a straight portion which extendsproximally from and at a substantial angle relative to the proximal endof the supportive segment that contacts the aortic wall. Providing aconfiguration of a guide catheter, such as the present invention, whichfocuses on combining all of these factors to provide an optimal guidecatheter results in a guide catheter that functions appreciativelybetter than the Judkins guide catheter or previous catheters used forangioplasty catheterization of the left main coronary artery. Althoughseveral previous catheters have been discussed, none of these aremanufactured or provided on a large scale (other than the Judkins guidecatheter) and are not used commonly because they are not practical inuse and/or do not sufficiently improve the performance of the basicshape of the Judkins guide catheter from which they are adapted.

An angioplasty guide catheter of the present invention is adapted foruse with a left main coronary artery within a cardiovascular system. Theguide catheter has a distal end portion such that with a distal tip ofthe distal end portion coaxially intubated within an ostium of the leftmain coronary artery (i.e., fully disposed within the cardiovascularsystem), a portion of the distal end portion contacts and rests againstand is substantially contiguous with a wall of the ascending aorta and adistal end of the contact portion is substantially directly opposite theostium of the left main coronary artery. In addition, a portion of thedistal end portion of the guide catheter defines a generally rectilinearaxis of support extending from the distal end of the contact portionacross the ascending aorta to the ostium of the left main coronaryartery.

The guide catheter of the present invention in a relaxed state prior toinsertion within the cardiovascular has a configuration that causes theadvantageous orientation of the guide catheter in the aortic complex.The guide catheter in its relaxed state includes a first straightportion and a distal end portion. The distal end portion includes asecond straight portion extending distally from the first straightportion. A first (or tertiary) curve portion of the catheter is definedby the junction of the first straight portion and the second straightportion and forms a mild obtuse angle of between 130° to 150°. A second(or secondary) curve portion extends distally from the second straightportion and has an overall curvature with an arc of about 150° to 180°and includes at least one curvaceous segments. A third straight portionof the guide catheter extends distally from the secondary curve portion.The arc of the second curve portion is oriented to generally face theinterior of the first curve portion. Accordingly, when the second curveportion has an 180° arc, the second straight segment is substantiallyparallel to the third straight segment. A fourth straight portion of theguide catheter extends distally from the third straight portion todefine a primary curve portion of the catheter having an obtuse angle ofbetween 140° to 160°.

The guide catheters of the present invention, yield many advantages overprevious prior art guide catheters (such as the Judkins-style guidingcatheter). These guide catheters of the present invention have anoverall configuration or basic shape that is substantially differentthan a Judkins-style guide catheter. Accordingly, when the guidecatheters of the present invention are deployed in the cardiovascularsystem, an orientation is achieved within the ascending aorta and ostiumof the left main coronary artery that is superior (i.e., better) to thecorresponding orientation achieved by a Judkins-style guide catheter.

The primary feature of superior (i.e., better) orientation of the guidecatheters of the present invention is that, when disposed in the aorticcomplex, a contact portion of the guide catheter is established in asubstantially contiguous manner against the aortic wall for asubstantial length (at least about 1.5 centimeters). Moreover, a distalend of this contact portion is positioned against the aortic wallsubstantially directly opposite the ostium of the left main coronaryartery. This provides a point of support for the guide catheter thatdirectly opposes stenotic pushback forces directed outwardly from theostium of the left main coronary artery. In addition, a distal tipportion of the guide catheters of the present invention (including thethird and fourth straight portions) when disposed in the aortic complexprovide a generally rectilinear axis of support that extendssubstantially across the ascending aorta from the distal end of thecontact portion to the ostium of the left main coronary artery. Thisaxis of support substantially directly opposes the axis of the stenoticpush back forces thereby substantially diminishing the potential forprolapse of the distal tip portion of the guide catheters of the presentinvention.

This advantageous orientation of the guide catheters of the presentinvention (when in the aortic complex) result directly from theconfiguration of the guide catheters when in a relaxed state prior toinsertion in the cardiovascular system. Foremost, the guide catheters ofthe present invention have a transition portion including the tertiarycurve portion and the second straight portion positioned between thefirst straight portion and the secondary curve portion. The transitionportion forms an obtuse angle of between 130° to 150°. This transitionportion causes the second straight portion and a proximal portion of thesecondary curve portion to form the contact portion (in use) that restssubstantially contiguous against the wall of the ascending aorta. Thepresence of the transition portion causes the second straight portion torest naturally against the ascending aortic wall thereby allowing theprimary point of backup support (at a distal end of the area of support,i.e., a distal end of the contact portion) to be positioned very low inthe ascending aorta as compared to the single point of backup supportfor a Judkins-style catheter. The primary point of backup support forthe guide catheters of the present invention is a point along theascending aortic wall substantially directly opposite the ostium of theleft main coronary artery. Moreover, because the second straight portionof the guide catheter of the present invention rests naturally againstthe ascending aortic wall , a large area of general backup support (thesubstantially contiguous contact portion) is provided for the guidecatheter which makes it quite difficult to dislodge the guide catheterfrom its desired orientation.

In addition, the presence of the tertiary curve portion provides morebends in the guide catheter (than a Judkins-style guide catheter) whendisposed in the aortic complex thereby making each bend in the cathetera milder angle to allow a fuller transmission of distal pushing forcesthrough the guide catheter. Moreover, the mild obtuse angle (about 160°)of the primary curve portion of the guide catheter and the long fourthstraight portion (at least about equal to or longer than the thirdstraight portion) cause the distal tip portion to align substantiallycoaxially within the ostium of the left main coronary artery. The lengthof the fourth straight portion causes the primary curve portion to bepositioned within the ascending aorta, i.e., outside the ostium of theleft main coronary artery.

All of these advantages of the guide catheter of the present inventionare gained by redesigning the basic configuration of the guide catheter(in its relaxed state). Accordingly, when the guide catheter of thepresent invention is fully disposed in the aortic complex, asubstantially different and superior (i.e., better) orientation isachieved over the previous prior art catheters (e.g. Judkins-style).Moreover, these advantages are achieved without adding additionalstructure "locking" mechanism, support flaps, "bracing" means, and thelike) to the distal end portion of the guide catheter. For example, theguide catheter of the present invention has means for stabilizing(supporting) the guide catheter against (or relative to) the wall of theascending aorta such that the guide catheter is supported by theascending aortic wall at a point substantially directly opposite theostium of the left main coronary artery. Moreover, the means forstabilizing is the contact portion of the guide catheter defined by thesecond straight portion and the proximal portion of the secondary curveportion. Accordingly, unlike the prior art (e.g. Shiu) the stabilizingmeans of the guide catheter of the present invention is defined orformed by an outer portion (or surface) of the wall of the tubularmember that comprises the guide catheter. The guide catheter of thepresent invention lacks the complex and bulky structure of the previousprior art catheters that attempted to modify the Judkins-style catheter.Instead, the guide catheter of the present invention provides superiorperformance by making a fundamental change in the overall shape of guidecatheters for the left main coronary artery.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A and 1B are side and front views, respectively, of a portion ofthe catheter of the prior art;

FIG. 1C is a cross sectional view of a portion of a cardiovascularsystem with the catheter of FIGS. 1A and 1B inserted therein;

FIG. 1D is an enlarged cross-sectional view taken along the line 1D--1DFIG. 1C;

FIGS. 2A-2C, 3A-3C, and 6A-6C are views similar to FIGS. 1A-1C,respectively, but depicting alternate embodiments of the presentinvention; and

FIGS. 4A-4D and FIGS. 5A-5D are views similar to 1A-1D, respectively,but depicting additional three embodiments of the catheter of thepresent invention.

FIG. 7 is a plan view of a guide catheter of the present invention.

FIG. 8A is a cross-sectional view of a portion of a cardiovascularsystem with a guiding catheter of the present invention disposed thereinalong with a positioning wire extending through the catheter.

FIG. 8B is a cross-sectional view of the cardiovascular system with aguiding catheter of the present invention disposed therein without thepositioning wire extending therethrough.

FIG. 8C is a sectional view of the cardiovascular system with a guidingcatheter of the present invention fully disposed therein and having aballoon catheter extending therethrough.

FIG. 8D is a cross-sectional view of a portion of a cardiovascularsystem with a Judkins guide catheter of the prior art disposed therein.

FIG. 8E is a cross-sectional view of a portion of a cardiovascularsystem with a guiding catheter of the present invention disposedtherein.

FIG. 9 is a plan view of a guiding catheter of the present invention.

FIG. 10 is a plan view of a guiding catheter of the present invention.

FIG. 11 is a plan view of a guiding catheter of the present invention.

FIG. 12 is a plan view of a guiding catheter of the present invention.

FIG. 13 is a plan view of a guiding catheter of the present invention.

DESCRIPTION OF THE PRIOR ART

Referring to FIGS. 1A and 1B of the drawings, the reference numeral 10refers, in general, to a well known prior art catheter, commonlyreferred to as a "Judkins" catheter. The catheter 10 is in the form ofan elongated tubular member having a straight portion 12 (shownpartially in FIGS. 1A and 1B) and a distal end portion consisting of astraight portion 14 forming an extension of the straight portion 12. Thetubular member is bent to form a curved portion 16 which extends fromthe straight portion 14 for approximately 180°. A straight portion 18extends from the curved portion 16 and parallel to the straight portion14. A tip portion 20 extends from, and is perpendicular to, the straightportion 18. A typical Judkins catheter would have straight portions 18and 20 of 4 centimeters ("cm.") and 1 cm., respectively, in length; andthe curved portion 16 would have a radius of curvature of approximately1 cm. The catheter 10 is usually fabricated of a plastic materialselected to exhibit flexibility and softness yet permit adequate "torquecontrol" i.e., the ability to transmit twisting forces along its lengthso that it can be located and maneuvered precisely within acardiovascular system by skilled manipulation of its proximal end, aswill be described.

A typical cardiovascular system is shown in FIGS. 1C and 1D and isreferred to, in general, by the reference numeral 22. The system 22includes an aorta 24 which extends through the body and curves aroundfor approximately 180° and then branches into a right coronary artery 28and a left main coronary artery 30. An aortic valve 32 extends betweenthe right coronary artery 28 and the left main coronary artery 30 and isconnected to the heart (not shown). As better shown in FIG. 1D, theright coronary artery 28 and the left main coronary artery 30 arenormally angularly spaced approximately 120°.

The prior art catheter 10 is designed for use as a diagnostic catheteror a guiding catheter for treatment of stenotic lesions, or the like, inthe left coronary artery 30. To this end, the catheter 10 is insertedinto the system 22 and is manipulated so that, ideally, the leading, ordistal, end portion of the catheter 10 is positioned into the lumen of,the left main coronary artery 30 and used to guide other catheters, suchas balloon, laser or atherectomy catheters, or the like (not shown) intothe left main coronary artery 30.

To assist in advancing the catheter 10 through the system 22 arelatively stiff wire is initially inserted into the catheter 10 tostraighten it out and, after the catheter is completely inserted, thewire is withdrawn, causing the catheter to take the position shown inFIG. 1C. During this procedure, the proximal end portion 10a of thecatheter extends outside the system 22 and is manipulated by rotationand guidance in a known manner until the tip portion 20 hopefully alignswith the left main coronary artery 30 in a coaxial relationship. As aresult of this operation, the straight portions 14 and 18 are spreadapart and the end of the tip portion 20 is inserted in the lumen of theleft main coronary artery 30.

However, due to the particular configuration of the Judkins catheter 10,the tip 20 is often misaligned with the left main coronary artery 30 asshown in FIG. 1C, and is thus not located coaxially with the latterartery. Thus, when an inner catheter (not shown) is passed through thecatheter 10, the former often strikes the wall of the aorta or left maincoronary artery increasing the risk of damage. Also, the catheter 10does not provide optimum support and guidance of other catheters ordevices that are passed through the catheter 10. Further, the curvedportion 16, which is shown resting against the inner wall of the aorta24 in FIG. 1C, is located a considerable distance above the ostium ofthe artery 30, thus dissipating some of the axial forces transmittedthrough the catheter during manipulation thereof.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

The catheter of the present invention is specifically designed toovercome the aforementioned deficiencies of the Judkins type catheter10, and one embodiment of the catheter of the present invention is shownin general by the reference numeral 36 in FIGS. 2A and 2B. The catheter36 is in the form of in elongated tubular member having a straightportion 38 (shown partially in FIGS. 2A and 2B) and extending from theproximal end portion (not shown) of the catheter. The catheter 36includes a distal end portion formed by a straight portion 40, a curvedportion 42, another straight portion 44 and a tip portion 46. Thestraight portion 40 extends at an angle to the straight portion 38, andthe curved portion 42 extends from the straight portion 40 forapproximately 180°. The straight portion 44 extends from the curvedportion 42 and parallel to the straight portion 40, and the tip portion46 extends from, and at an angle to, the straight portion 44. Accordingto a feature of the embodiment of FIGS. 2A and 2B, the distance D1(measured vertically as viewed in FIGS. 2A and 2B) between the outercurvature of the curved portion 42 and the junction between the straightportion 44 and 46 is one-half the distance D2 between the latter outercurvature and the end of the tip portion 46.

For example, the distance between the outer curvature of the curvedportion 42 and the junction of the straight portion 40 and the straightportion 44 is approximately 1.5 cm., the distance D1 is approximately 2cm. and the distance D2 is approximately 4 cm. The radius of the curvedportion 42 is approximately 1 cm. which forms a diameter of 2 cm.corresponding to the distance between the straight portions 40 and 44.The angle between the straight portions 38 and 40 is between 30° and50°, and the angle between the straight portions 44 and 46 is between20° and 50°. It is understood that these distances and angles representonly one possible configuration of the catheter 36. For example, thelength of straight portion 40 can be increased to other values withinthe scope of the invention and thus provide increased support.

The catheter 36 can be fabricated of a material, such as plastic, whichexhibits optimum flexibility and softness while permitting thetransmission of twisting forces along its length by manipulation of itsproximal end.

FIG. 2C depicts the cardiovascular system 22 of FIG. 1C with thecatheter 36 inserted therein. Prior to insertion a relatively stiff wire(not shown) is inserted in the catheter 36 and the catheter inserted inthe system 22. Then the wire is withdrawn and the catheter 36, by virtueof its pre-shape shown in FIGS. 2A and 2B, takes the position shown withthe tip portion 46 precisely aligned with the lumen of the left maincoronary artery 30 in a coaxial relationship. It is also noted that, asa result of the foregoing, a greater portion of the catheter 36 restsagainst the inner wall of the aorta 24 and bends at a lesser angle whencompared to the Judkins catheter 10. Also the straight portion 40 restsagainst the inner wall of the aorta 24 and is lower in the artery, andthus more opposite the ostium of the artery 30, when compared to theJudkins catheter 10. Thus, the axial forces transmitted along the lengthof the catheter 36 are better transmitted to the end portion thereof formore precise manipulation and location.

An alternate embodiment of the catheter of the present invention isshown in general by the reference numeral 50 in FIGS. 3A and 3B. Thecatheter 50 is in the form of an elongated tubular member having astraight portion 52 (shown partially in FIGS. 3A and 3B) and a distalend portion consisting of a straight portion 54, a curved portion 56, astraight portion 58, and a tip portion 60. The straight portion 54extends at an angle to the straight portion 52, and the curved portion56 extends from the straight portion 54 for approximately 180°. Thestraight portion 58 extends from the curved portion 56 at an angle tothe straight portion 54. The tip portion 60 extends at an angle to thestraight portion 58 and parallel to the straight portion 54. The end ofthe tip portion 60, which forms the distal end of the catheter 50,extends behind the straight portion 52 as viewed is FIG. 3A.

According to a feature of this embodiment, the distance D1, measuredvertically as viewed in FIGS. 3A and 3B, between the outer curvature ofthe curved portion 56 and the junction between the straight portion 58and the curved portion 56 is approximately one-third the distance D2between the latter curvature and the end of the tip portion 60.

For example, the distance between the outer curvature of the curvedportion 56 and the junction of the straight portion 52 and the straightportion 54 could be approximately 3.0 cm., the length of the tip portion60 is approximately 0.5 cm., the distance D1 is approximately 1.3 cm.and the distance D2 is approximately 4.0 cm. The angle that the straightportion 52 makes with the straight portion 54 is between 30° and 50°,and the angle that the straight portion 58 makes with the straightportion 54 is 20-40°.

Referring to FIG. 3C, the catheter 50 is inserted in the cardiovascularsystem 22 in the manner described above. Due to the pre-shape of thecatheter 50 shown in FIGS. 3A and 3B, the tip portion 60 issubstantially coaxially aligned with the lumen of the left main coronaryartery 30 and a portion of the catheter 50 lies in contact with theinner wall of the aorta 24. Thus the embodiment FIGS. 3A-3C enjoys theadvantages of the embodiment of FIGS. 2A-2C.

The catheter depicted in the alternate embodiment of FIGS. 4A and 4B isshown in general by the reference numeral 64, and is for a specialapplication commonly referred to as "posterior take-off" of the leftmain coronary artery, as will be described. The catheter 64 is in theform of an elongated tubular member having a straight portion 66 (shownpartially in FIGS. 4A and 4B) extending from the proximal end of thecatheter, and a distal end portion consisting of a straight portion 68 acurved portion 70, a straight portion 72 and a tip portion 74. Thestraight portion 68 extends at an angle to the straight portion 66, andthe curved portion 70 extends from the straight portion 68 forapproximately 180°. The straight portion 72 extends from the curvedportion 70, and the tip portion 74 extends from, and at an angle to thestraight portion 72.

As better shown in FIG. 4B, the straight portions 66 and 72 are bent outof the plane formed by the straight portion 68 and the curved portion70. The straight portion 66 extends at an angle A1 of between 60° and70°, to the straight portion 68 and the straight portion 72 extends atan angle A2 of between 20° and 40° to the straight portion 68. Thelength of the portions 68, 72 and 74 are approximately 6 cm., 3 cm. and1.5 cm., respectively and the radius of the curved portion 70 isapproximately 1 cm. The tip portion 74 extends at an angle A3 of between40° and 50° from the straight portion 72 in a first plane (FIG. 4A), andat an angle A4 from the straight portion 72 (FIG. 4B) of between 25° and35° in a second plane perpendicular to the first plane.

The catheter 64 has a special application in connection with acardiovascular system 22 in which the left main coronary artery 30 isangularly displaced posteriorly a finite distance from its normallocation as shown in FIG. 4D. More particularly, the normal position ofthe left main coronary artery is shown by the dashed lines and by thereference numeral 30. However the left main coronary artery sometimes isangularly displaced posteriorally from its normal position to a positionshown, for example, by the solid lines and by the reference numeral 30.The catheter 64 is especially configured for this location and, wheninserted into the cardiovascular system 22 in the manner describedabove, it takes the position shown in FIG. 4C, with the angled tip 74coaxially aligned with the lumen of the left main coronary artery 30'notwithstanding the posterior displacement of the artery. The principlesof the long tip catheter can also be applied to this catheter 64,particularly adding a 1.5 to 3.0 cm. long segment proximally for bettersupport and extending the tip of the catheter to 2.0 or 2.5 cm.

Another embodiment of the catheter of the present invention is shown ingeneral by the reference numeral 80 in FIGS. 5A and 5B and is also aspecial application catheter designed for treatment of a right coronaryartery that is angularly displaced from its normal position and has ananterior takeoff. More particularly, the catheter 80 consists of aelongated tubular member having a straight portion 82 (shown partiallyin FIGS. 5A and 5B) and a distal end portion formed by a straightportion 84 and a tip portion 86. The straight portion 84 extends fromthe straight portion 82 at an angle B1 in a first plane (FIG. 5A) whichis between 50° and 70°, and, as shown in FIG. 5B, at an angle B2 in asecond plane perpendicular to the first plane which is between 20° and40°. The tip portion 86 extends from the straight portion 84 and is alsoangled with respect thereto in two planes. Referring to FIG. 5A, the tipportion 86 extends from the straight portion 84 at an angle B3, whichmay be between 20° and 30°, in the first plane. As shown in FIG. 5B, thetip portion 86 extends at an angle B4 of between 40° and 50° to thestraight portion 84. The length of the straight portions 84 and 86 canbe 6 cm. and 1.5-2.0 cm., respectively.

As shown in FIGS. 5C and 5D, the catheter 80 is designed for treatmentof a right coronary artery 28' (FIG. 5D) which is shown anteriorlydisplaced from its normal position shown by the reference numeral 28. Asa result of the pre-shape of the catheter 80 shown in FIGS. 5A and 5B,after insertion in the cardiovascular system 22 in the manner describedabove, it takes the position shown in FIG. 5C with the angled tipportion 86 extending in more coaxial alignment with the lumen of thedisplaced right main coronary artery 28'.

According to the embodiment of FIGS. 6A and 6B, a catheter 90 isprovided which consists of an elongated tubular member having a straightportion 92 (shown partially in FIGS. 6A and 6B) and a distal end portionconsisting of a first curved portion 94, a second curved portion 96 anda tip portion 98. The first curved portion 94 is concave (when viewedfrom the front as shown in FIG. 6B) having a radius of curvature ofapproximately 3 cm. and its second curved portion is convex having aradius of curvature of approximately 1 cm. The second curved portion 96continues from the first curved portion 94 when the latter extendsapproximately 30-45° from the vertical as shown in FIG. 6A. The lengthof the tip portion 98 is approximately 1 cm., and the tip portion 98extends in the same direction as the straight portion 92, i.e.vertically as viewed in FIG. 6A. The lengths of the curves 94 and 96 aresuch that the outside wall of the tip portion 98 is spaced a distance D1of approximately 2.5 cm. from the outside wall of the straight portion92.

FIG. 6C depicts the cardiovascular system 22 with the catheter 90inserted therein. The catheter 90 is a special application catheterdesigned to provide treatment for a venous bypass 100 which connects theaorta 24 to the distal segment of the right coronary artery 28. Due tothe pre-shape of the catheter 90 shown in FIGS. 6A and 6B, the catheter,after insertion into the cardiovascular system 22 in the mannerdescribed above, it takes the position relative to the lumen of thevenous bypass 100 shown in FIG. 6C. In this position the distal end ofthe tip portion 96, which forms the distal end of the catheter 90 iscoaxially aligned with the lumen of the venous bypass 100.

According to an alternate embodiment of the catheter 90, the straightportion 92 can extend to an angle of approximately 10° to 30° to thevertical, as viewed and shown by the dashed line in FIG. 6A.

It is thus seen that the catheters embodied in the present invention areeach specifically configured for more precise coaxial alignment with aparticular artery in the cardiovascular system. Also, the catheters ofthe present invention provide improved support and guidance ofassociated catheters, such as balloon catheters, during angioplasty.Further, the catheters of the present invention form relatively smallangles when inserted in the cardiovascular system, thus minimizing thedissipation of axial force during use.

Moreover, additional embodiments of the guide catheters presentinvention for catheterization of a left main coronary artery providefurther illustration of the features of embodiments of the presentinvention described above for catheterization of a left main coronaryartery. These additional embodiments of the present invention includethe same strategically ordered sequence of straight portions, curveportions, and transition portions resulting in more precise coaxialalignment of the guide catheter within an artery, increased support andguidance for balloon catheters, and a fuller transmission of pushingforces. The previously described guide catheter embodiments of thepresent invention for catheterization of a left main coronary artery,e.g., the guide catheter embodiment of FIG. 2A, and these additionalembodiments include a unique transition portion created between anotherwise conventional first straight portion and an otherwiseconventional secondary curve portion of the guide catheter of thepresent invention. This transition portion in the previously describedembodiment (e.g., the FIG. 2A embodiment) and these additionalembodiments include a tertiary curve portion (in FIG. 2A, the curvedportion between the first straight portion 38 and the second straightportion 40) and a second straight portion (40 in FIG. 2A). Theseadditional embodiments also include the long fourth straight tip portion(46 in FIG. 2A) and the mild angle primary curve portion of the FIG. 2Aembodiment. These additional embodiments provide further examplesillustrating the strategic sequencing of straight, curved, andtransition portions that yield the many advantages of the guidecatheters of the present invention, particularly those used forcatheterization of a left main coronary artery.

A guide catheter 110, another preferred embodiment of the presentinvention, is illustrated in FIG. 7. The guide catheter 110 is adaptedfor use with a left main coronary artery to facilitate advancement of adilatation balloon catheter (or other intravascular devices) through theguide catheter 110. The guide catheter 110 is shown in FIG. 7 in arelaxed or "equilibrium" state prior to insertion into thecardiovascular system and includes an elongate flexible tubular shaft112 which extends from a proximal portion 114 to a distal portion 116.The guide catheter 110 includes a first straight portion 118 and adistal end portion 119 extending distally from a distal end of the firststraight portion 118. The first straight portion 118 of the guidecatheter 110 extends from a proximal end 120 of the catheter 110 to apoint 122 (a distal end of the first straight portion 118) locateddistally along the shaft 112 (distal of the proximal end 120). The firststraight portion 118 preferably has a length of about 90 to 95centimeters but can be made shorter or longer to accommodate differentpatient anatomies.

A tertiary curve portion 123 of the guide catheter 110 is defined by thecurvature in the catheter 110 between the point 122 and a point 126 (adistal end of the tertiary portion 123) located distally along thecatheter shaft 112 relative to the point 122. A second straight portion124 of the guide catheter 110 extends rectilinearly between the point126 and a point 128 (a distal end of the second straight portion)located distally along the catheter shaft 112 from the point 126. Thecurvature of the tertiary curve portion 123 creates an obtuse anglebetween the first straight portion 118 and the second straight portion124 of between 130° and 150°. As shown in FIG. 7, the obtuse angle ofthe tertiary curve portion 123 is about 140° and the curvature of thetertiary curve portion 123 is smooth and uniform. The tertiary curvedportion 123 and the second straight portion 124 together define atransition portion 125 of the guide catheter 110 forming an obtuse angleof between 130° to 150° between a distal end of the first straightportion 118 and a proximal portion of a secondary curve portion 130 ofthe guide catheter 100.

The secondary curve portion 130 of the guide catheter 110 is defined bythe curvaceous segment of the catheter shaft 112 extending from thepoint 128 to a point 132 (a distal end of the curve portion 130) locateddistally along the shaft 112 (distal of the point 128). The transitionportion 125 of the guide catheter 110 is a curvaceous segment (having atleast one curved or angled portion) comprised of the preferredcombination of two discrete portions: the tertiary curve portion 123 andthe second straight portion 124. The transition portion 125 causes theproximal portion 131 of the secondary curve portion 130 (and the secondstraight portion 124) to form the preselected obtuse angle of between130° and 150° relative to the first straight portion 118 (both in arelaxed state and as deployed in the cardiovascular system).

The secondary curve portion 130 forms a curvaceous segment (having atleast one curve or angled portion) and defines a transition portionhaving a smooth curvature or being a combination of discrete straightand angled segments forming an overall curvature with an arc ofapproximately 150° to 180° between the point 128 (the distal end of thesecond straight portion 124) and the point 132 (the proximal end of thethird straight portion 134).

A distal tip portion of the guide catheter 110 includes a third straightportion 134 and a fourth straight portion 138. The third straightportion 134 of the guide catheter 110 extends from the point 132distally along the catheter shaft 112 to a point 136. A primary curveportion 137 of the guide catheter 110 is defined by the curvature ofcatheter shaft 112 between point 136 (a distal end of the third straightportion) and a point 140 located distally along the catheter shaft 112(distal from the point 136). The fourth straight portion 138 of theguide catheter 110 extends distally from the point 140 and together withthe third straight portion 134 defines the distal tip portion of theguide catheter 110. The primary curve portion 137 has an obtuse angle ofapproximately 140° to 160° formed between the third straight portion 134and the fourth straight portion 138, and as shown in FIG. 7 has anobtuse angle of about 160°.

The arc of the secondary curve portion 130 generally faces the interiorof the obtuse angle of the primary curve portion 137. Accordingly, whenthe arc is 180°, the second straight portion 124 and the third straightportion 134 are substantially parallel to each other.

The second straight portion 124 preferably extends rectilinearly atleast about 1.5 centimeters. The third straight portion 134 extendsrectilinearly about 0.5 centimeters and the fourth straight portionextends rectilinearly about 1.5 centimeters. The second straight portion124 can have a length slightly less than 1.5 centimeters if desired. Theradius of the secondary curve portion 130 perferably is about 1centimeter.

Although the guide catheter 110 can be a single piece of tubing with auniform degree of flexibility throughout its length, the guide catheter110 preferably is made of two or three principal tubular segments witheach successively distal segment having a greater degree of flexibility.As seen in FIG. 7, the embodiment of the guide catheter 110 having threeprincipal flexibility segments includes a first flexibility tubularsegment 142 extending from the proximal end 120 of guide catheter 110 toa bond member 148 located at a distal portion of the third straightportion 134 (in the distal portion 116 of the guide catheter 110). Asecond flexibility tubular segment 144 extends distally from the bondmember 148 to a third flexibility tubular tip segment 146. The nature ofthe three principal segments and their different flexibility aredescribed in co-pending application Ser. No. 07/908,250 INTRAVASCULARGUIDE CATHETER and which is incorporated by reference herein. In oneembodiment, the first segment 142, the second segment 144, and the thirdsegment 146 have a Shore A durometer hardness of about, 63, 40, and 35respectively. The bond member 148 has a Shore A durometer hardness ofabout 50, intermediate the hardness of the first segment 142 and thesecond segment 144.

A double flexibility segment embodiment (not shown) of the guidecatheter 100 has two principal segments of flexibility, each with adifferent degree of flexibility. The double flexibility embodiment has atip segment (like tip segment 146) with a select degree of flexibilityand a main segment (all portions proximal to the tip segment) with adifferent select degree of flexibility. The double flexibility segmentembodiment differs from the triple flexibility segment embodiment inthat the second flexibility segment 144, having a hardness intermediatethat of the first (i.e., main) flexibility segment 142 and the tipsegment 146, is absent in the double flexibility segment embodiment.Although it is preferred to have a bond ring member (like member 148)positioned between the main and tip flexibility segments, the doubleflexibility segment may omit a bond ring member between the main segmentand the tip segment. The main segment of the double flexibility segmentembodiment of the guide catheter 110 has a Shore A hardness of 63 (or67, 70) and the tip segment has a Shore A hardness of 35. The optionalbond ring member would have a Shore A hardness (e.g., about 46)intermediate that of the first segment and tip segment.

The catheter shaft 112 of both the double flexibility segment embodimentand the triple flexibility segment embodiment (FIG. 7) are made of anouter layer and an inner layer. The outer layer is preferably formed ofa polyether block amide material, such as PEBAX® available from ATOCHEM,INC. (Glen Rock, N.J.) and a radiopaque compound, such as bismuthcarbonate. The inner layer is a coating of lubricous material such asTEFLON® available from E.I. DuPont Nemours & Co. (Wilmington, Del.). Thefirst principal segment 142 and the second (intermediate) segment 144(in the triple flexibility embodiment) preferably have a reinforcinglayer of wire braiding (of stainless steel wire) extending along thecatheter shaft 112 between the inner layer and the outer layer.

In use, as shown in FIG. 8A, the guide catheter 110 is inserted throughthe cardiovascular system so that its distal end portion 119 is disposedwithin the aortic complex including an ascending aorta 158, an arch ofthe aorta 152, and a descending aorta 153. A left main coronary artery154 extends laterally from the ascending aorta 158 and has a leftanterior descending (LAD) branch 155 and a circumflex (CFX) branch 156.An ostium 157 of the left main coronary artery 154 forms an interfacewith the ascending aorta 158.

The guide catheter 110 is inserted into the cardiovascular system at afemoral artery (not shown) with a stiff wire 159 extending through theentire length of the lumen of the guide catheter 110. The stiff wire 159is of sufficient rigidity to temporarily overcome the curve portions ofthe guide catheter 110 so that the guide catheter 110 takes on the shapeof the stiff wire 159 as the stiff wire 159 passes through thecardiovascular system. The guide catheter 110 (with the stiff wire 159therein) are advanced distally through the cardiovascular system untilthe fourth straight portion 138 of the guide catheter 110 is adjacentthe ostium 157 of the left main coronary artery 154 (as shown in FIG.8A).

As seen in FIG. 8A, the guide catheter 110 (with the wire 159 extendingtherethrough) forms a relatively smooth curve to extend about the archof the aorta 152 and down through the ascending aorta 158. Once thecatheter 110 is in position adjacent the left main coronary artery 154,the stiff wire 159 is removed from within the guide catheter 110allowing the guide catheter 110 to attempt to resume its relaxed stateconfiguration (the relaxed state shape prior to insertion in thecardiovascular system, as shown in FIG. 7). This results in the guidecatheter 110 assuming the orientation as shown in FIG. 8B.

The orientation and shape of the guide catheter 110 as shown in FIG. 8Billustrates that the curved portions of the catheter 110, primarily thesecondary curved portion 130, reassert their original curvatures as muchas possible while being limited by the structure of the ascending aorta158 and the arch of the aorta 152. The secondary curved portion 130,while trying to reassert its original 180° curvature, forces the fourthstraight tip portion 138 of guide catheter 110 toward and against (ornear) a wall of the ascending aorta 158 adjacent the ostium 157 of theleft main coronary artery 154. However, the secondary curve portion 130is limited from regaining its full 180° curvature because the contact ofthe fourth straight portion 138 against the wall of the ascending aorta158 prevents the secondary curved portion 130 from fully returning toits original curvature. This creates stored energy within the secondarycurve portion 130 of the guide catheter 110. Similarly, the tertiarycurved portion 123 is prevented from returning fully to its originalcurvature such that energy is also stored within the catheter shaft 112in the region of the tertiary curved portion 123.

The guide catheter 110 is advanced distally further from the orientationshown in FIG. 8B and maneuvered until in the orientation shown in FIG.8C. This orientation (FIG. 8C) corresponds to the proper positioning ofthe guide catheter 110 within the cardiovascular system so that theguide catheter 110 can facilitate the advancement and support of aballoon dilatation catheter 161 through the guide catheter 110. As seenin FIG. 8C, the distal end portion 119 of the guide catheter 110 ispositioned within the aortic complex such that the tertiary curvedportion 123 is disposed against (or very near) a wall of the ascendingaorta 158. The second straight portion 124 of the guide catheter 110extends distally from the tertiary curve portion 123 to rest against andbe substantially contiguous with the wall of the ascending aorta 158. Asdisposed within the ascending aorta 158 as shown in FIG. 5C, thetertiary curved portion 123 generally assumes its relaxed state(preinsertion shape) obtuse angle of about 130° to 150° such that thesecond straight portion 124 rests naturally against the wall of theascending aorta 158, i.e., retaining little or no stored energy in thetertiary curved portion 123. This lack of stored energy in the tertiarycurve portion 123 promotes stability in the guide catheter 110 to retainits desired orientation in the ascending aorta because the guidecatheter 110 will not attempt to release any undesired stored energy.

As seen in FIG. 8C, a proximal portion 131 of the secondary curvedportion 130 extends distally from the second straight portion 124 andalso rests against and substantially contiguous with the wall of theascending aorta 158. Accordingly, the second straight portion 124 andthe proximal portion 131 of the secondary curved portion 130 togetherdefine a contact portion of the guide catheter 110 for resting againstand substantially contiguous with the wall of the ascending aorta 158.From its distal end 135, the contact portion extends along the ascendingaortic wall generally above the ostium 157, as seen in FIG. 8C. Aremaining distal portion of the secondary curved portion 130 (beginningwith approximately the apex of its pre-insertion, i.e., relaxed state,curvature) extends laterally away from the wall of the ascending aorta158 so that the third straight portion 134 and the fourth straightportion 138 together extend laterally across the ascending aorta 158wherein the distal end of the fourth straight portion 138 coaxiallyintubates within the ostium 157 of the left main coronary 154.

As seen in FIG. 8C, the third straight portion 134 of the guide catheter110 extends slightly downward as it extends across the ascending aorta158 from the distal portion of the secondary curve portion 130 near thewall of the ascending aorta 158.

The primary curved portion 137 of the guide catheter 110 is shown inFIG. 8C, resting in its natural relaxed state orientation of about 160°(e.g., 140 to 160) which causes the fourth straight portion 138 of thedistal end portion of the guide catheter 110 to extend slightly upwardthrough the ascending aorta 158 until the distal end of the fourthstraight portion 138 intubates within the ostium 157. The third straightportion 134 and the fourth straight portion 138 (when properlypositioned within the aortic complex as shown in FIG. 8C) togetherdefine a generally rectilinear axis of support extending across theascending aorta from a point along the wall of the ascending aortasubstantially directly opposite the ostium to the ostium. Although thethird and fourth straight portions extend a substantial distance acrossthe ascending aorta, the distal portion of the secondary curve portion130 spans the remaining distance across the ascending aorta 158.

In this preferred orientation shown in FIG. 8C, a distal end 135 of thecontact portion (the contact portion including the second straightportion 124 and a proximal portion 131 of the secondary curved portion130) rests against the wall of the ascending aorta 158 at a pointsubstantially directly across from the ostium 157 of the left maincoronary artery 154. This preferred orientation of the guide catheter110, with the contact portion resting against and substantiallycontiguous with the wall of the ascending aorta 158 and the distal end135 of the contact portion positioned substantially directly across fromthe ostium 157, can be achieved with virtually any anatomical variationis the ascending aorta 158 and the arch of aorta 152. The orientation ofthe guide catheter 110 as shown in FIG. 8C has extremely importantadvantages in supporting advancement of a balloon catheter across thestenosis 167 (as shown in the circumflex branch 156 of the left maincoronary artery 154). Moreover, this advantageous orientation of theguide catheter 110 within the aortic complex is directly attributable tothe shape and configuration (including a particular sequence of straightand curved portions) of the guide catheter 110 in its relaxed stateprior to insertion in the cardiovascular system.

A primary structural advantage of the guide catheter 110 (in its relaxedstate) is the presence of a mild obtuse angle transition portion (thetertiary curve portion 123 and the second straight portion 124) locatedproximal of the secondary curve portion 130 in the guide catheter 110.This transition portion directly causes the second straight portion 124and the proximal portion of the secondary curve portion 130, when fullydisposed in the ascending aorta 158, to form the contact portion thatrests substantially contiguous with the wall of the ascending aorta 158.Having a contact portion resting substantially contiguously against aback wall of the ascending aorta 158 causes the distal end 135 of thecontact portion to be disposed substantially directly across from theostium of the left main coronary artery. This provides a primary pointof backup support for the guide catheter 110 directly opposite theostium. Accordingly, when resistive forces are exerted by a tightstenosis and pushed back on the guide catheter 110, the guide catheter110 has back up support provided by the distal end 35 of the contactportion to effectively counter the stenotic "pushback" forces. Thisprevents the guide catheter 110 from prolapsing (i.e., being pushed out)out of the ostium 157 because, as seen in FIG. 8D, the primary point ofsupport is directly opposite the direction of the stenotic "push back"forces.

The direct opposition of the pushback forces by the point of backupsupport is further complemented by the third straight portion 134 andfourth straight portions 138 because those portions together define agenerally rectilinearly axis of support extending from the ostium acrossthe ascending aorta to the point of support (the distal end 135 of thecontact portion) resting against the wall of the ascending aorta 158.This axis of support direct opposes the stenotic pushback forces andsubstantially eliminates any possibility of the "pushback" forcesleveraging or bending the third and fourth straight portions out theostium 157.

FIG. 8E illustrates the action of the stenotic "pushback" forcesleveraging the distal tip portion of the Judkins prior art guidecatheter out of a ostium (see phantom lines showing prolapsed distal tipportion). This prolapsing of the Judkins guide catheters occurs becausethe point of support P_(s) (which is provided (approximately) by theapex of the secondary curve portion) rests against the wall of theascending aorta substantially above the ostium of the left main coronaryartery. This results from the long straight segment G of the Judkinsguide catheter that extends from the ostium across the ascending aortato the "back" wall of the ascending aorta at a substantial angle andthus creating an axis of support for the Judkins guide catheter to be atsubstantial angle relative to the axis of the "stenotic" pushbackforces. Accordingly, when pushback forces exerted against the Judkinsguide catheter become sufficiently large, the distal tip portion of theJudkins guide catheter prolapses because the pushback forces are onlyindirectly opposed by the Judkins guide catheter.

Indeed, the primary backup support for the Judkins guide catheterapparently results not from a structural axis of support and point ofsupport but rather from energy stored in secondary curve portion of theJudkins guide catheter because the secondary curve wants to regain itsnatural pre-insertion 180° (or 150°) curvature. Accordingly, this storedenergy tends to force the straight segment G and segment H of theJudkins guide catheter toward and into the ostium. Once the stenoticpushback forces exceed this stored energy in the secondary curve portionof the Judkins catheter, no substantial structural support is availablefrom the guide catheter to provide support against the pushback forcesbecause the axis of support does not directly (and sufficiently) opposethe axis of pushback forces. Instead, the point of support for theJudkins guide catheter (substantially above the ostium) acts like ahinge as the pushback forces bend the straight segment G (and segment H)away from the ostium into the "prolapse" position shown by the phantomlines.

The guide catheter 110 of the present invention does not rely on storedenergy in the secondary curve portion 130 to counter stenotic pushbackforces directed proximally through the balloon catheter. Rather, anystored energy in the secondary curve portion 130 tends to maintain thefourth straight portion 138 in a position directed slightly upward intothe ostium 157 of the left main coronary artery 154. The stenoticpushback forces are countered by the guide catheter 110 of the presentinvention by structural support in two ways: from the primary point ofbackup support substantially directly across from the ostium and fromthe generally rectilinear axis of support provided by a combination ofthe third and fourth straight portions extending across the ascendingaorta.

Moreover, the guide catheter 110 has a large area of support (A_(s))between the substantially contiguous contact portion and the wall of theascending aorta, thereby creating a significant interface of frictiontherebetween. This effectively anchors the contact portion against theascending aortic wall. Thus, to extent that any stenotic pushback forceacts laterally relative to the axis of support, the guide catheter 110will be unlikely to become dislodged from its desired orientation in theaorta. Moreover, a greater force can be applied when distally advancinga balloon catheter through the guide catheter 110 because the guidecatheter 110 will be less likely to become dislodged (i.e., slip)because of the larger area of support. This substantially contiguouscontact portion also reduces the possibility of dissection of theascending aorta 158 because the stenotic "pushback" forces exerted onthe aortic wall are spread out and thus substantially minimized at anyparticular point along the aortic wall.

The superior backup support of the guide catheter 110 of the presentinvention is achieved primarily from the point of support (provided bythe distal end 135 of the contact portion) being positionedsubstantially directly across from the ostium of the left main coronaryartery. The tertiary curve portion 123 of the transition portion permitsthe substantially contiguous positioning of the contact portion againstthe aortic wall and more importantly, the positioning of the distal end135 of the contact portion "low" within the ascending aorta 158. Thisresult is achieved because the obtuse angle of the tertiary curveportion 123 is substantially the same (about 140°) when the catheter 110is disposed fully within the aortic complex as the curvature of thetertiary curve portion 123 in its relaxed state prior to insertionwithin cardiovascular system (about 140°). This reduces the problem oflocalized (initial contact with the ascending aorta) unnecessary storedenergy within the guide catheter 110. This lack of stored energy allowsthe second straight portion 124 to rest naturally against the wall ofthe ascending aorta 158 because no force is attempting to direct thesecond straight portion 124 toward the ostium as occurs with segment Gof the Judkins guide catheter (see FIG. 8E). Accordingly, a distal endof the second straight portion 124 (and the proximal portion 131 of thesecondary curved portion 130) can rest against the aortic wall very lowin the ascending aorta 158. Without this transition portion includingtertiary curve portion 123 and the second straight portion 124, theconventional orientation of previous (Judkins-type) guide catheterswould result in which a straight portion extends away from the ascendingaortic wall because the secondary curve portion "banks" off the aorticwall (like a single point on a line) as shown in FIG. 8E.

In addition to the structural support advantages from the tertiary curveportion 123, the guide catheter 110 of the present invention also has anadvantageous long distal tip portion with a primary curve having a mildobtuse angle. The fourth straight portion 138 of guide catheter 110 islonger than the third straight portion 134 of the guide catheter 110resulting in the primary curve portion 137 being located within theascending aorta 158 outside of the ostium of the left main coronaryartery (unlike the Judkins primary curve which is positioned within theostium). As shown in FIGS. 8C and 8D, the primary curve portion 137 ispositioned about halfway between the aortic wall and the ostium.However, the length of the fourth straight portion 138 can be aboutequal to (or even slightly less) than the length of the third straightportion 134 if necessary so that depending on patient anatomy theprimary curve portion 137 is preferably (not necessarily) positionedwithin the ascending aorta halfway between the back wall of theascending aorta and the ostium. Similarly, a fourth straight portion inlater embodiments (FIGS. 9-13) of the present invention need not belonger than a third straight portion of those guide catheters. Moreover,the obtuse angle between the fourth and third straight portions is quitemild (about 160°) which yields an overall generally rectilinear axis ofsupport extending from the contact portion of the guide catheter 110against the aortic wall across the aorta and into the ostium 157.

This provides several advantages. First, because the obtuse anglebetween the fourth straight portion 138 and third straight portions 134is relatively mild (between about 140° and 160°), this avoidsdissipating pushing forces applied to advance the balloon catheterdistally through the left main coronary artery 154 and across a tightstenosis. Second, this unique configuration permits the distal tipportion of the guide catheter 110 to align substantially coaxiallywithin the ostium 157 and lumen of the left main coronary artery 154 asshown in FIG. 8C. Third, this configuration maximizes the stability and"backup support" achieved by the substantially contiguous contactportion (against the wall of the ascending aorta 158) because the axisof support of the guide catheter 110 (provided primarily by the thirdstraight portion 134 and fourth straight portion 138) substantiallydirectly opposes the axis of stenotic "push back" forces as shown inFIG. 8D. In addition, the mild bend (an obtuse angle of about 160°, orbetween 140° to 160°) of the primary curve portion 137 of the guidecatheter 110 further facilitates the transmission of pushing forces fromthe proximal end to the distal end of the balloon catheter because ofthe lack of acute or sharp 90° angles in the distal end portion of theguide catheter 110 when fully disposed in the aortic complex (FIG. 8C).The effects of this configuration increase the probability of theballoon catheter crossing a tight stenosis without prolapse of the guidecatheter 110.

In addition, several advantages of the distal tip portion combination ofthe guide catheter 110 result from the fourth straight portion 138 beingrelatively long, preferably longer than the third straight portion 134.First, this causes the apex of the primary curve portion 137 to beoutside the ostium 157 preferably halfway between the ascending aorticwall and the ostium. This allows only the fourth straight portion 138 tobe intubated within the ostium 157 (of the LMCA). Because no part of theprimary curve portion 137 nor the third straight portion 134 is withinthe ostium 157, and because of the mildness of the obtuse angle of theprimary curve portion 137, the fourth straight portion 138 can be trulycoaxially intubated within the ostium 157. Moreover, because the fourthstraight portion 138 is longer than the third straight portion 134, theostium 157 can be intubated coaxially much deeper then a guide catheterwith a short straight portion (distal of the primary curve) because theprimary curve portion of the guide catheter 110 does not obstruct deepintubation. Moreover, the ability of the fourth straight portion 138 todeeply intubate further accentuates coaxially positioning because as thefourth straight portion 138 is deeper within the ostium 157, thisincreases the surface contact between an outer surface of the wall ofthe guide catheter 110 and the surface of the wall of the ostium 157.This increased surface area contact tends to straighten the fourthstraight portion 138 within the ostium so that it becomes increasinglycoaxially positioned as the fourth straight portion 138 is intubatedfurther within the ostium.

Another advantage of the long fourth straight portion 138 (longer thanthe straight portion just distal to the secondary curve portion)associated with keeping the apex of the primary curve portion 137outside the ostium 157 is that the apex of the primary curve portion 137is not leveraged against (i.e., banked) the wall of the ostium 157. Thisdecreases the risk of injuring the ostia wall because of localizedpressure against the wall. Finally, because the fourth straight portion138 is relatively long, this allows the combination of the thirdstraight portion 134, primary curve portion 137 and fourth straightportion 138 to form the generally rectilinearly axis of support acrossthe ascending aorta.

Another advantage of the guide catheter 110 is that the orientation ofthe guide catheter 110 as shown in FIG. 8C can be achieved despiteanatomical variations from person to person (except cases of grossmalformation). Anatomical variations between persons relate primarily tovariations in the size, shape and in particular, circumference of thelumen. For example, the lumen of the ascending aorta 158 may be narrowerthan normal or broader than normal (dilated). Moreover, although thewall of the ascending aorta 158 may have more curvature in a dilatedaorta, this too is a minor anatomical variation.

The pre-insertion (relaxed state) configuration of the guide catheter110 is constructed to interact with an ascending aorta 158 despite thenormal variations in the aorta (aside from cases of gross malformation).In particular, the second straight portion 124 and the proximal portionof the secondary curved portion 130 of the distal end portion togetherprovide a contact portion for resting substantially contiguously againstthe wall of the ascending aorta 158. This remains true despitevariations in the size of the ascending aorta 158. To account for aorticsize variations, a physician need only choose an appropriate sizecatheter just as would be done when using conventional catheters. Forinstance, a 3.5 distal tip size catheter would be used for a narrowaorta, a 4.0 distal tip size would be used for a normal aorta, and a 4.5(or 5.0, 6.0) distal tip size guide catheter would be used for a dilatedaorta. The distal tip size corresponds to the distance between thedistal end of the guide catheter and the apex of the secondary curveportion. Moreover, in addition to having different size guide cathetersto account for aortic size variations, to the extent that an aortavaries in size/shape, the secondary curved portion 130 readilyaccommodates this change so that the contact portion (including thesecond straight portion 124 and the proximal portion 131 of thesecondary curved portion 130) remains in contact with the ascendingaortic wall in a substantially contiguous manner.

The physician also can choose a catheter of the present invention withslightly different angles within the bounds of the invention toaccommodate anatomical variations. For example, the obtuse angle of thetertiary curve portion 130 can be an angle in the range of 130° to 150°.Thus, if a more open angle tertiary curve portion 130 is required forthe second straight portion 124 to rest substantially contiguous againstthe ascending aortic wall, then the physician can choose a guidecatheter 110 off the shelf having a tertiary curve portion 123 with a150° obtuse angle. Similarly, guide catheters of the present inventioncan be constructed so that in all cases, the tertiary curve portion willpermit a contact portion to rest substantially contiguous against thewall of the ascending aorta and allow a distal end of the contactportion to be positioned substantially directly across from the ostium.

Next, several additional embodiments of the present invention arepresented and provide examples of variations on dimensions of the curveportions and straight portion segments of the guide catheter 110. Thevariations relate primarily to selective increases in length of thestraight portions. The variations in dimension provide catheters with adifferent distal tip size and different second straight portion size toaccommodate different patient anatomies so that the substantiallycontiguous contact portion and low point o support can be establishedagainst the ascending aortic wall despite anatomical variations. Ingeneral, the guide catheters with smaller distal tip sizes and secondstraight portion lengths accommodate narrower and normal aortic roots,whereas the longer distal tip sizes (and second straight portions)accommodate dilated (wider) aortic roots. All the features of additionalembodiments are the same as for the guide catheter 110 except for thespecific changes in length of the straight portion segments. All ofthese additional embodiments enjoy the advantages of the guide catheter110 that result from its unique combination of curve portions (includingthe tertiary curve portion 123) and optimal length straight segments.

Another embodiment of the present invention is a guide catheter 160illustrated in FIG. 9 in its relaxed state prior to insertion in acardiovascular system. The guide catheter 160 includes a shaft 162extending from a proximal portion 164 to a distal portion 166. A firststraight portion 168 of the guide catheter 160 extends rectilinearlyfrom a proximal end 170 of the catheter 160 to a point 172 locateddistally along the catheter shaft 162. A tertiary curve portion 173 ofthe guide catheter 160 is defined by the curvature of the obtuse angle α(about 140°) of the catheter shaft 162 between the point 172 and a point176 located distally along the shaft 162. The obtuse angle of thetertiary curve portion 173 can be between 130° and 150°. A secondstraight portion 174 of the guide catheter 160 extends rectilinearly anddistally about 1.5 centimeters from the point 176 to a point 178. Asecondary curved portion 180 of guide catheter 160 extends distally fromthe point 178 to point 182 forming an arc of approximately 180°. Thecurvature of the secondary curve portion 180 can form an arc of between150° and 180° if desired. A third straight portion 184 of the guidecatheter 160 extends rectilinearly about 0.75 centimeters between apoint 182 and a point 186 located distally along catheter shaft 162. Aprimary curve portion 187 of guide catheter 160 is defined by thecurvature of the catheter 160 from the point 186 to a point 190 locateddistally along the shaft 162. The obtuse angle of the primary curveportion 187 is about 160° as shown in FIG. 9 but can be between 140° and160°. A fourth straight portion 188 of the guide catheter 162 extendsdistally and rectilinearly about 1.75 centimeters from the point 190 onthe shaft 162.

The guide catheter 160 is inserted into the cardiovascular system in themanner previously described for guide catheter 110 and as depicted inFIGS. 8A-8D. The guide catheter 160 assumes the same advantageousorientation within the ascending aorta and ostium of the left maincoronary artery as is shown in FIG. 8C (as shown for the guide catheter110). As shown in FIG. 9 the guide catheter 162 is constructed of threesegments, each with a different degree of flexibility. The guidecatheter 160 in FIG. 9 has a first flexibility segment 192 with a ShoreA hardness of 63, a second flexibility segment 194 with a Shore Ahardness of 40, and a third flexibility tip segment 196 with a Shore Ahardness of about 35. A bond ring member 198 is sandwiched between adistal end of the first segment 192 and a proximal end of the secondsegment 194, and has a hardness of about 51.

Instead of the triple flexibility segment construction, the guidecatheter 160 can have a double flexibility segment constriction asdescribed for the guide catheter 110. In addition, for both the doubleand triple flexibility segment construction of the guide catheter 160,the materials of PEBAX®, TEFLON®, and wire braiding are used as wasdescribed for the guide catheter 110.

The guide catheter 160 has a distal tip size 3.5 which corresponds to adistance of 3.5 centimeters between the utmost distal end of the guidecatheter shaft 162 and the apex of the secondary curve portion 180. Thisdistal tip size is used to accommodate slightly narrow or normal sizeaortic root anatomies.

Another embodiment of the present invention, a guide catheter 200, asshown in FIG. 10 includes a shaft 202 extending from a proximal portion204 to a distal portion 206. A first straight portion 208 of the guidecatheter 200 extends about 90-95 centimeters from a proximal end 210 toa point 212 located distally along the catheter shaft 202. A tertiarycurve portion 213 of the guide catheter 200 is defined by the curvatureof the catheter shaft 202 extending from the point 212 to a point 216located distally along the shaft 202. The tertiary curve portion 213 hasan obtuse angle α of about 140° as shown in FIG. 10 but can be between130° to 150°. A second straight portion 214 of the guide catheter 200extends distally and rectilinearly about 1.5 centimeters from the point216 to a point 218 located distally along the shaft 202. A secondarycurved portion 220 of the catheter 200 is defined by the curvature ofthe guide catheter shaft 202 extending in an approximately 180° arc frompoint 218 to a point 222 located distally along the catheter shaft 202.A third straight portion 224 of the guide catheter 200 extends distallyand rectilinearly about 1 centimeter from the point 222 to a point 226located distally along the catheter shaft 202. A fourth straight portion228 of the guide catheter 200 extends distally and rectilinearly about 2centimeters from a point 230 located just distally of the point 226. Aprimary curve portion 229 of the guide catheter 200 is defined by thecurvature in the catheter shaft 202 formed between the third straightportion 224 and the fourth straight portion 228. The obtuse angle of theprimary curve on 229 is about 160° as shown in FIG. 10 but can bebetween about 140° to 160°.

The guide catheter 200 is inserted into the cardiovascular system in themanner previously described for guide catheter 110 and as depicted inFIGS. 8A-8D. The guide catheter 200 assumes the same advantageousorientation within the ascending aorta and ostium of the left maincoronary artery as is shown in FIG. 8C (as shown for the guide catheter110). As shown in FIG. 10 the guide catheter 200 is constructed of threesegments, each with a different degree of flexibility. The guidecatheter 200 in FIG. 10 has a first flexibility segment 232 with a ShoreA hardness of 63, a second flexibility segment 234 with a Shore Ahardness of 40, and a third flexibility tip segment 236 with a Shore Ahardness of about 35. A bond ring member 238 is sandwiched between adistal end of the first segment 232 and a proximal end of the secondsegment 234, and has a hardness of about 51.

Instead of the triple flexibility segment construction, the guidecatheter 200 can have a double flexibility segment construction asdescribed for the guide catheter 110. In addition, for both the doubleand triple flexibility segment constructions of the guide catheter 200,the materials of PEBAX®, TEFLON®, and wire braiding are used as wasdescribed for the guide catheter 110.

The guide catheter 200 has a distal tip size 4.0 which corresponds to adistance of 4.0 centimeters between the utmost distal end of the guidecatheter shaft 202 and the apex of the secondary curve portion 220. This4.0 distal tip size is primarily used in normal or average sizeascending aortic roots.

Another embodiment of the present invention is a guide catheter 240which is shown in FIG. 11 in a relaxed state prior to insertion in thecardiovascular system. The guide catheter 240 includes a shaft 242extending from a proximal portion 244 to a distal portion 246. A firststraight portion 248 of the guide catheter 240 extends distally about 90to 95 centimeters from a proximal end 250 to a point 252 locateddistally along the catheter shaft 242. A tertiary curve portion 253 isdefined by the curvature of the catheter shaft 242 extending distallyfrom the point 252 to a point 256 located distally therefrom. Thetertiary curve portion 253 forms an obtuse angle α of about 140° asshown in FIG. 11 but can be between 130° to 150°. A second straightportion 254 of the guide catheter 240 extends distally and rectilinearlyabout 2 centimeters from the point 256 to a point 258 located distallyalong the catheter shaft 242. A secondary curve portion 260 of the guidecatheter 240 is defined by the curvature of the catheter shaft 242extending distally from the point 258 to a point 262 located distallyalong the catheter shaft 242. The secondary curve portion 260 as shownin FIG. 11 forms an arc of about 180° but can have an arc of aboutbetween 150° to 180°. A third straight portion 264 of the guide catheter240 extends distally and rectilinearly about 1.25 centimeters from thepoint 262 to a point 266 located distally along the catheter shaft 242.A primary curve portion 269 of the guide catheter 240 is defined by thecurvature of the catheter shaft 242 between the point 266 and a point270 located distally therefrom along the catheter shaft 242. The primarycurve portion 269 forms an obtuse angle of about 160° as shown in FIG.11 but can be between about 140° to 160°. A fourth straight portion 268of the guide catheter 240 extends rectilinearly about 2.25 centimetersdistally from the point 270.

The guide catheter 240 is inserted into the cardiovascular system in themanner previously described for guide catheter 110 and as depicted inFIGS. 8A-8D. The guide catheter 240 assumes the same advantageousorientation within the ascending aorta and ostium of the left maincoronary artery as is shown in FIG. 8C (as shown for the guide catheter110). As shown in FIG. 11 the guide catheter 240 is constructed of threesegments, each with a different degree of flexibility. The guidecatheter 240 in FIG. 11 has a first flexibility segment 272 with a ShoreA hardness of 63, a second flexibility segment 274 with a Shore Ahardness of 40, and a third flexibility tip segment 276 with a Shore Ahardness of about 40, and a third flexibility tip segment 276 with aShore A hardness of about 35. A bond ring member 278 is sandwichedbetween a distal end of the first segment 272 and a proximal end of thesecond segment 274, and has a hardness of about 51.

Instead of the triple flexibility segment construction, the guidecatheter 240 can have a double flexibility segment construction asdescribed for the guide catheter 110. In addition, for both the doubleand triple flexibility segment constructions of the guide catheter 240,the materials of PEBAX®, TEFLON®, and wire braiding are used as wasdescribed for the guide catheter 110.

The guide catheter 240 has a distal tip size 4.5 which corresponds to adistance of 4.5 centimeters between the utmost distal end of the guidecatheter shaft 242 and the apex of the secondary curve portion 260.

Another embodiment of the present invention, a guide catheter 280, isshown in FIG. 12 in a relaxed state prior to insertion in thecardiovascular system. The guide catheter 280 includes a shaft 282extending from a proximal portion 284 to a distal portion 286. A firststraight portion 288 of the guide catheter 280 extends about 90 to 95centimeters from a proximal end 290 to a point 292 located distallyalong the catheter shaft 282. A tertiary curve portion 293 of the guidecatheter 280 is defined by the curvature of the catheter shaft 282 fromthe point 292 to a point 296 located distally therefrom. The tertiarycurve portion 293 forms an obtuse angle a of about 140° as shown in FIG.12 but can be between about 130° to 150°. A second straight portion 294of the guide catheter 280 extends distally and rectilinearly about 2.5centimeters from the point 296 to a point 298 located distally along thecatheter shaft 282. A secondary curve portion 300 of the guide catheter280 extends distally from the second straight portion 244 and is definedby the curvature of the catheter shaft 282 forming an arc of about 180°(as shown in FIG. 12) between the point 298 and a point 302 locateddistally therefrom. The secondary curve portion 300 can have an arc ofbetween 150° to 180°. A third straight portion 304 of the guide catheter280 extends distally and rectilinearly about 1.5 centimeters from thepoint 302 to a point 306 located distally therefrom along the cathetershaft 282. A primary curve portion 307 of the guide catheter 280 isdefined by the curvature of the catheter shaft 282 between the point 306and a point 308 extending distally therefrom. The primary curve portion307 as shown in FIG. 12 forms an obtuse angle of about 160° but thatobtuse angle can be between 140° to 160°. A fourth straight portion 310of the guide catheter 280 extends distally from the point 308 andrectilinearly about 2.5 centimeters.

The guide catheter 280 is inserted into the cardiovascular system in themanner previously described for guide catheter 110 and as depicted inFIGS. 8A-8D. The guide catheter 280 assumes the same advantageousorientation within the ascending aorta and ostium of the left maincoronary artery as shown in FIG. 8C (as shown for the guide catheter110). As shown in FIG. 12 the guide catheter 280 is constructed of threesegments, each with a different degree of flexibility. The guidecatheter 280 in FIG. 12 has a first flexibility segment 312 with a ShoreA hardness of 63, a second flexibility segment 314 with a Shore Ahardness of 40, and a third flexibility tip segment 316 with a Shore Ahardness of about 35. A bond ring member 318 is sandwiched between adistal end of the first segment 232 and a proximal end of the secondsegment 314, and has a hardness of about 51.

Instead of the triple flexibility segment construction, the guidecatheter 280 can have a double flexibility segment construction asdescribed for the guide catheter 110. In addition, for both the doubleand triple flexibility segment constructions of the guide catheter 280,the materials of PEBAX®, TEFLON®, and wire braiding are used as wasdescribed for the guide catheter 110.

The guide catheter 280 has a distal tip size 5.0 which corresponds to adistance of 5.0 centimeters between the utmost distal end of the guidecatheter shaft 282 and the apex of the secondary curve portion 300. This5.0 distal tip size with the longer second straight portion is designedto accommodate larger size and dilated ascending aortic roots.

Another embodiment of the present invention, a guide catheter 320, isshown in FIG. 13 in a relaxed state prior to insertion in thecardiovascular system. The guide catheter 320 has a shaft 322 extendingfrom a proximal portion 324 to a distal portion 326. A first straightportion 328 of the guide catheter 320 extends about 90 to 95 centimetersdistally from a proximal end 330 to a point 332 located distally alongthe catheter shaft 322. A tertiary curve portion 333 of the guidecatheter 320 is defined by the curvature of the catheter shaft 322between the point 332 and a point 336 located distally therefrom. Thetertiary curve portion 333 forms an obtuse angle α of about 140° asshown in FIG. 13 but can be between 130° to 150°. A second straightportion 334 of the guide catheter 320 extends rectilinearly about 2.5centimeters and distally from the point 336 to a point 338 locateddistally along the catheter shaft 322. A secondary curve portion 340 ofthe guide catheter 320 is defined by the curvature of the catheter shaft322 extending distally from the point 338 to a point 342 locateddistally along the catheter shaft 322 and forming an arc ofapproximately 180° as shown in FIG. 13. The arc of the secondary curveportion 340 can be between 150° to 180°. A third straight portion 344 ofthe guide catheter 320 extends distally and rectilinearly about 2centimeters from the point 342 to a point 346 located distally therefromalong the catheter shaft 322. A primary curve portion 347 of the guidecatheter 320 is defined by the curvature of the catheter 322 extendingdistally from the point 346 to a point 350. As shown in FIG. 13, theprimary curve portion 347 forms an obtuse angle of about 160° but thisangle can be between 140° and 160°. A fourth straight portion 348 of theguide catheter 320 extends about 3 centimeters distally andrectilinearly from the point 350 to form a tip portion of the catheter320. As shown in FIG. 13, the fourth straight portion 348 overlaps withthe first straight portion 328 such that the fourth straight portion 348extends in a plane different than that of the first straight portion328.

The guide catheter 320 is inserted into the cardiovascular system in themanner previously described for guide catheter 110 and as depicted inFIGS. 8A-8D. The guide catheter 320 assumes the same advantageousorientation within the ascending aorta and ostium of the left maincoronary artery as shown in FIG. 8C (as shown for the guide catheter110). As shown in FIG. 13 the guide catheter 320 is constructed of threesegments, each with a different degree of flexibility. The guidecatheter 320 in FIG. 13 has a first flexibility segment 352 with a ShoreA hardness of 63, a second flexibility segment 354 with a Shore Ahardness of 40, and a third flexibility tip segment 356 with a Shore Ahardness of about 35. A bond ring member 358 is sandwiched between adistal end of the first segment 352 and a proximal end of the secondsegment 354, and has a hardness of about 51.

Instead of the triple flexibility segment construction, the guidecatheter 320 can have a double flexibility segment construction asdescribed for the guide catheter 110. In addition, for both the doubleand triple flexibility segment constructions of the guide catheter 320,the materials of PEBAX®, TEFLON®, and wire braiding are used as wasdescribed for the guide catheter 110.

The guide catheter 320 has a distal tip size 6.0 which corresponds to adistance of 6.0 centimeters between the utmost distal end of the guidecatheter shaft 322 and the apex of the secondary curve portion 340. This6.0 distal tip size is provided for large and dilated aortic roots.

The guide catheters of the present invention, yield many advantages overprevious prior art guide catheters (such as the Judkins-style guidingcatheter) in connection with the goal of catheterization of the leftmain coronary artery. These guide catheters of the present inventionhave an overall configuration or basic shape that is substantiallydifferent than a Judkins-style guide catheter. Accordingly, when theguide catheters of the present invention are deployed in thecardiovascular system (as in FIG. 8C), an orientation is achieved withinthe ascending aorta and ostium of the left main coronary artery that issuperior (i.e., better) than the corresponding orientation achieved by aJudkins-style guide catheter.

The primary feature of superior (i.e., better) orientation of the guidecatheters of the present invention is that, when disposed in the aorticcomplex, a contact portion of the guide catheter is established in asubstantially contiguous manner against the aortic wall for asubstantial length (at least about 1.5 centimeters). Moreover, a distalend of this contact portion is positioned against the aortic wallsubstantially directly opposite the ostium of the left main coronaryartery. This provides a primary point of backup support for the guidecatheter that directly opposes stenotic pushback forces directedoutwardly from the ostium of the left main coronary artery. In addition,a distal tip portion of the guide catheters of the present invention(including the third and fourth straight portions) when disposed in theaortic complex provide a generally rectilinear axis of support thatextends substantially across the ascending aorta from the distal end ofthe contact portion to the ostium of the left main coronary artery. Thisaxis of support substantially directly opposes the axis of the stenoticpush back forces (FIG. 8D), thereby substantially diminishing thepotential for prolapse of the distal tip portion of the guide cathetersof the present invention. Furthermore, the guide catheter lumen at thedistal tip is aligned essentially coaxially with the lumen of the leftmain coronary artery.

This advantageous orientation of the guide catheters of the presentinvention (when in the aortic complex) result directly from theconfiguration of the guide catheters when in a relaxed state prior toinsertion in the cardiovascular system. Foremost, the guide catheters ofthe present invention have a transition portion including a tertiarycurve portion and a second straight portion positioned between a firststraight portion and a secondary curve portion. The transition portionforms an obtuse angle of between 130° to 150°. This transition portioncauses the second straight portion and a proximal portion of thesecondary curve portion to form the contact portion (in use) that restssubstantially contiguous against the wall of the ascending aorta. Thepresence of the transition portion causes the second straight portion torest naturally against the ascending aortic wall thereby allowing theprimary point of backup support (a distal end of the contact portion) tobe positioned very low in the ascending aorta as compared to the singlepoint of backup support for a Judkins-style catheter. The primary pointof backup support for the guide catheters of the present invention is apoint along the ascending aortic wall substantially directly oppositethe ostium of the left main coronary artery. Moreover, because thesecond straight portion of the guide catheter of the present inventionrests naturally against the ascending aortic wall, a large area ofgeneral backup support is provided for the guide catheter which makes itquite difficult to dislodge the guide catheter from its desiredorientation.

In addition, the presence of the tertiary curve portion provides morebends in the guide catheter (than a Judkins-style guide catheter) whendisposed in the aortic complex thereby making each bend in the cathetera milder angle to allow a fuller transmission of distal pushing forcesthrough the guide catheter. Moreover, the mild obtuse angle (about 160°)of the primary curve portion of the guide catheter and the long fourthstraight portion (preferably longer than the third straight portion)cause the distal tip portion to align substantially coaxially within theostium of the left main coronary artery. The long fourth straightportion also maintains the primary curve portion within the ascendingaorta outside of the ostium of the left main coronary artery.

Although the present invention has been described with reference topreferred embodiments, workers skilled in the art will recognize thatchanges may be made in form and detail without departing from the spiritand scope of the invention.

It is understood that several variations may be made in the guidecatheters of the present invention without departing from the scope ofthe invention. For example, the catheters embodied in the presentinvention are not limited for use as guiding catheters but can haveother uses for treatment of the cardiovascular system, such as use asdiagnostic, balloon, laser and atherectomy catheters, etc. Also, thespecific lengths and angles of the specific examples of the catheters ofthe present invention set forth above can be varied within the scope ofthe invention. Moreover, it is understood that, instead of the welldefined lengths and angles shown and described in the above examples,the distal end portion of the catheters of the present invention canform more smoother curves within the scope of the invention.

What is claimed is:
 1. A method for advancing a catheter through theaorta and into a coronary ostium, the aorta having an arch and an innerwall opposite the ostium, comprising the steps of:providing a catheterincluding an elongate catheter body having a proximal end and a distalend and having a central lumen from the proximal end to the distal endadapted to slidably receive a therapeutic catheter, the catheter bodyincluding a tip at the distal end of the catheter body adapted toremovably lodge in the coronary artery ostium; advancing the catheterbody distal end through the aortic arch; and engaging the aorta innerwall with a portion of the catheter body such that when the distal endof the catheter is positioned in the ostium, the catheter body engagesthe opposite wall of the aorta along a line having a length of about 1.5cm or greater.
 2. A method in accordance with claim 1, wherein theostium is the left coronary ostium.
 3. A method in accordance with claim2, further comprising the step:further advancing the catheter distal endinto the coronary artery ostium while engaging the aorta inner wall withthe body portion.
 4. A method for advancing a catheter through an aortaand into a branch artery, the aorta having an arch and an inner wallopposite the branch artery, comprising the steps of:providing a catheterincluding a tubular member having a shaft, an integral profiled portion,and an integral, substantially straight tip portion, the tip portionbeing adapted to axially engage the branch artery; wherein the catheterprofiled portion comprises, in order from the shaft portion to the tipportion, a first bend, a first substantially straight leg, a secondbend, a second substantially straight leg, and a third bend; advancingthe catheter tip portion through the aorta; and engaging the branchartery with the tip portion, such that when the tip portion is engagedwith the branch artery, the profiled portion engages the aorta wallopposite the branch artery along a line.
 5. A method in accordance withclaim 4, further comprising the step:further advancing the catheter tipportion into the branch artery while engaging the aorta inner wall withthe profiled portion.